肩の関節造影検査:MRIによる通常の肩関節と回旋筋腱板の解剖学

肩の関節造影検査:MRIによる通常の肩関節と回旋筋腱板の解剖学

肩の関節造影検査:MRIによる通常の肩関節と回旋筋腱板の解剖学


このe-Anatomyのモデュールは関節造影検査のMRIによる肩と回旋筋腱板の解剖学に特化されています。

 

肩のMRI関節造影は、男性患者に対しGE Signa Pioneer 3T MRIを用いてカリフォルニアのShin Imaging所属のCorey Chakarun医師により実施されました。
本検査は、前下関節唇靱帯複合体の慢性損傷のため正常なものではありません。

 

ガドリニウム造影剤 12ml(希釈度1 :200)注入を肩の関節に透視検査の元、前方アプローチで行った(患者は肩を軽く外部に回転させ回外の姿勢)。

 

そしてMRIは肩が中立の回転位置で(ABERのシークエンスを除く)肩の関節造影検査のMRIで通常使われる5つの異なるシークエンスで行われた。

  • Axial T1-weighted fat saturation
MR Arthrography of the shoulder in Axial T1 FS: Normal anatomy of the glenohumeral joint and of the rotator cuff. This MRI shows the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa
Axial T1 FS image shows the normal anatomy of the glenohumeral joint and the rotator cuff on a MR (Magnetic Resonance) arthrography of the shoulder. On this MRI the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa can be distinguished.

 

  • Oblique coronal T1-weighted fat saturation
Shoulder MR arthrogram on coronal F1 FS showing the anatomy of the normal glenohumeral joint and of the rotator cuff
This oblique coronal T1-weighted fat saturation image shows the anatomy of the normal glenohumeral joint and of the rotator cuff

 

  • Oblique coronal PD-weighted fat saturation
Shoulder MR Arthogram in coronal PD FS showing the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
This oblique coronal PD-weighted fat saturation image shows the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa

 

  • Oblique sagittal T1-weighted FSE
Shoulder MR arthrogram on sagittal T1 showing the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the glenohumeral ligaments
This oblique sagittal T1-weighted FSE image shows the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the lenohumeral ligaments

 

  • T1-weighted fat saturation in abduction and external rotation (ABER)
Shoulder MR arthrogram in the ABER position-T1 FS: the glenohumeral joint, the shoulder joint, the supraspinatus tendon, the glenoid labrum can be distinguished
This T1-weighted fat saturation was performed in abduction and external rotation (the ABER position). It shows the glenohumeral joint, the shoulder joint, the supraspinatus tendon and the glenoid labrum

 

 

解剖学構造はAntoine Micheau とDenis HoaによりMRI画像上に注釈されており、la nouvelle Terminologia Anatomica (TA2 – 2020) を使用し、肩の放射線解剖学の臨床において慣習的に使われる用語がいくつか追加されている。

 

 

MR Arthrography of the shoulder in Axial T1 FS: Normal anatomy of the glenohumeral joint and of the rotator cuff. This MRI shows the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa
図 1 - Axial T1 FS image shows the normal anatomy of the glenohumeral joint and the rotator cuff on a MR (Magnetic Resonance) arthrography of the shoulder. On this MRI the labrum, the tendons of the rotator cuff muscles, the glenohumeral ligaments, the articular capsule and the subacromial-subdeltoid bursa can be distinguished.
Shoulder MR arthrogram on coronal F1 FS showing the anatomy of the normal glenohumeral joint and of the rotator cuff
図 2 - This oblique coronal T1-weighted fat saturation image shows the anatomy of the normal glenohumeral joint and of the rotator cuff
Shoulder MR Arthogram in coronal PD FS showing the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
図 3 - This oblique coronal PD-weighted fat saturation image shows the rotator cuff, the musculotendinous cuff, the supraspinatus tendon, the infraspinatus muscle, the subacromial bursa and the subdeltoid bursa
Shoulder MR arthrogram on sagittal T1 showing the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the glenohumeral ligaments
図 4 - This oblique sagittal T1-weighted FSE image shows the articular surface of glenoid, the glenoid labrum, the bicipital-labrum complex and the lenohumeral ligaments
Shoulder MR arthrogram in the ABER position-T1 FS: the glenohumeral joint, the shoulder joint, the supraspinatus tendon, the glenoid labrum can be distinguished
図 5 - This T1-weighted fat saturation was performed in abduction and external rotation (the ABER position). It shows the glenohumeral joint, the shoulder joint, the supraspinatus tendon and the glenoid labrum
  • Normal Shoulder MRI and MR Arthrography: Anatomy and Technique. Seminars in musculoskeletal radiology.Llopis, Eva & Montesinos, Pau & Guedez, M & Aguilella, Luis & Cerezal, Luis. (2015). 19. 212-30. 10.1055/s-0035-1549316
  • The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale - Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11–21. doi:10.1007/s13244-011-0129-9
  • Transverse Thickening Along the Articular Surface of the Rotator Cuff Consistent With the Rotator Cable: Identification With MR Arthrography and Relevance in Rotator Cuff Evaluation. Kenneth Sheah, Miriam A. Bredella, Jon J. P. Warner, Elkan F. Halpern, and William E. Palmer American Journal of Roentgenology 2009 193:3, 679-686
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